Eat out or cook at home? It’s a simple decision made millions of times a day by hungry Americans, and for more and more of us, the answer is “dine out.”

A new report suggests you think twice because choosing to have a meal in a restaurant may double your chances of contracting a food-borne illness.

Researchers from the Center for Science in the Public Interest analyzed 10 years of data on more than 10,000 food-borne-illness outbreaks collected by the Centers for Disease Control and Prevention. Their findings show restaurants are the most frequent location for outbreaks—defined as a cluster of two or more illnesses resulting from the same contaminated food source—and are responsible for twice as many outbreaks as private homes.

“This report dispels the myth that if consumers would only cook their food properly, they wouldn’t get sick,” said Sarah Klein, senior food safety attorney for CSPI. “The numbers show that even in a restaurant, where food workers are required to undergo food safety training and are overseen by food safety managers, food-borne illness is still a concern.”

The National Restaurant Association says the industry depends on safe ingredients and that it has trained more than 5.6 million food service workers in safe handling and serving of food.

The numbers are telling. According to the 17-page report, between 2002 and 2011 there were 1,610 food-borne outbreaks linked to restaurants, causing 28,570 illnesses. Private homes were linked to 893 outbreaks, causing 12,980 illnesses. The CDC estimates that each year 48 million people get sick, 128,000 are hospitalized, and 3,000 die of food-borne diseases.

The issues restaurants face during food preparation are vastly different from a home cook’s.

“Dinnertime at home is unlikely to last six hours. At home, it’s a much more compressed time frame. In a restaurant, prep starts in the afternoon, and service can extend into late night. Food may be held at warm temperatures but not warm enough, or food that’s meant to be cold sits out too long,” Klein said. And cross-contamination in a kitchen can happen easily when the pace picks up during service.

The report’s findings echo a study published in 2006 by Dr. Tim Jones, Tennessee’s state epidemiologist, examining the risk factors associated with restaurant dining.

“Who calls up the health department and says my grandma gave me food poisoning yesterday? Nobody. Restaurant outbreaks are bigger, more obvious, and easier to investigate. They show up disproportionally,” said Jones. “If a 17-year-old working at a restaurant made a mistake at home, three of us would get sick. If he makes it at a restaurant, 700 get sick. Restaurants magnify errors.”

The new report also notes a 42 percent decline in the number of food-borne-illness outbreaks since 2002, perceived as good news by the restaurant industry.

“The fact that food-borne-disease outbreaks have declined during this period is evidence that we are making good progress,” said Joan McGlockton, vice president of industry affairs and food policy for the National Restaurant Association.

CSPI said the decline may not stem from fewer Americans getting sick but rather from illnesses going unreported. Falling budgets for public health departments may also play a role. The report also puts the number of unsolved outbreaks between 2002 and 2011 as high as 68 percent because the CDC lacked necessary information.

While there are concerns changes in the laboratory tests used to trace food-borne illnesses may hinder the ability of health departments to track outbreaks, Klein says the majority of the data analyzed for the report came prior to changes in lab methods. Changes in lab-testing methods would not affect the location where someone was exposed, she adds.

Produce, seafood, poultry, and beef were linked to half of all attributed outbreaks and illnesses, while norovirus and salmonella were the most commonly identified causes. Raw milk merited a special warning of its own. The report declares it an “urgent public health risk.”

“Of 104 outbreaks of illnesses linked to milk, 70 percent were caused by raw milk. In other words, although less than 1 percent of consumers drink raw milk, they bear 70 percent of the burden of illnesses caused by milk-borne outbreaks,” according to the report.

“These are very serious illnesses caused by pathogens like salmonella, E. coli, listeria, and campylobacter,” says Klein. “What’s distressing is raw milk is so often fed to children who are more vulnerable. There’s no scientific benefit. We’re talking about the mammary fluid from a bovine. It’s not magical milk from a unicorn.”

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